Department of Public Health Sciences, University of Virginia (UVA), UVA Cancer Center Research and Outreach Office, Christiansburg, VA, USA.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
Transl Behav Med. 2024 Oct 6;14(10):578-587. doi: 10.1093/tbm/ibae041.
The implementation of school-based obesity-prevention programs is understudied. Kids SIPsmartER is a 6-month, school-based, behavioral intervention for Appalachian middle school students and includes a teacher implementation strategy. Kids SIPsmartER effectively reduced students' sugar-sweetened beverages (SSB) when Researcher-Led. However, Teacher-Led effectiveness and fidelity are unknown. To explore the relative SSB effects when Kids SIPsmartER was Researcher-Led versus Teacher-Led and to examine teacher fidelity. This study of secondary outcomes used a quasi-experimental analytic approach of a Hybrid Type 1 effectiveness-implementation and cluster randomized controlled tria (RCT) of Kids SIPsmartER. Student SSB behaviors and teacher self-rated fidelity were assessed, respectively, with the validated Beverage Intake Questionnaire (BEVQ-15) and lesson-specific checklists. Analyses included descriptive statistics and modified two-part models with time-fixed effects and school-year cohort cluster controls. The analytic sample included students from six control schools (n = 220), six Researcher-Led intervention schools (n = 306), and five Teacher-Led intervention schools (n = 218), as well as eight teachers. Teacher-Led intervention students decreased SSB by -14.3 ounces/day (95% confidence interval = -15.4, -13.2; P < .001). Relative to control and to Researcher-Led intervention, the Teacher-Led treatment effect among students was -11.6 ounces SSB/day (P < .001, effect size = 0.75) and -4.3 (P = .004, effect size = 0.25), respectively. Teachers returned fidelity checklists for 90% of planned lessons. Fidelity averaged 94% (SD = 4.0%) among returned forms and 85% (SD = 18.9%) when missing forms were counted as zeros. Teachers can implement Kids SIPsmartER with high fidelity and produce statistically and clinically meaningful improvements in students' SSB behaviors. Findings have implications for the sustained implementation of Kids SIPsmartER and other school-based obesity-prevention programs. Clinical Trial information: NCT03740113.
基于学校的肥胖预防计划的实施情况研究较少。“Kids SIPsmartER”是一项针对阿巴拉契亚地区中学生的为期 6 个月的基于学校的行为干预措施，包括教师实施策略。当由研究人员主导时，“Kids SIPsmartER”有效地减少了学生的含糖饮料（SSB）摄入量。然而，由教师主导的有效性和保真度尚不清楚。本研究旨在探索当由研究人员和教师分别主导“Kids SIPsmartER”时，学生 SSB 行为的相对效果，并考察教师的保真度。本研究采用混合 1 型有效性-实施的准实验分析方法和聚类随机对照试验（RCT），对“Kids SIPsmartER”进行了二次结果研究。使用经过验证的饮料摄入量问卷（BEVQ-15）和特定课程检查表分别评估学生的 SSB 行为和教师自我评估的保真度。分析包括描述性统计和修改后的两部分模型，其中包含时间固定效应和学校年度队列聚类控制。分析样本包括来自六所对照学校（n=220）、六所研究人员主导干预学校（n=306）和五所教师主导干预学校（n=218）的学生，以及 8 名教师。由教师主导的干预组学生 SSB 摄入量减少了 -14.3 盎司/天（95%置信区间=-15.4，-13.2；P<0.001）。与对照和研究人员主导的干预组相比，教师主导的治疗效果在学生中为 -11.6 盎司 SSB/天（P<0.001，效应大小=0.75）和-4.3（P=0.004，效应大小=0.25）。教师返回了计划课程 90%的 fidelity 检查表。返回的表单中 fidelity 的平均值为 94%（SD=4.0%），当将缺失表单算作 0 时，fidelity 的平均值为 85%（SD=18.9%）。教师可以高度保真地实施“Kids SIPsmartER”，并使学生 SSB 行为产生统计学和临床意义上的显著改善。研究结果对“Kids SIPsmartER”和其他基于学校的肥胖预防计划的持续实施具有重要意义。临床试验信息：NCT03740113。
